Domain E on ABPMR Part II: communication, role play, hope and distress
By The MockOral.ai team. Updated October 2026. .
Domain E is where examiners ask you to talk to the patient or family, not about them. It is scored on its own, and it rewards a few skills you can practise: acknowledging emotion, giving honest information in plain language, and ending with a plan.
What Domain E measures
The ABPMR describes Domain E, Interpersonal and Communication Skills, as rating the concern, knowledge and skill you show in dealing with the patient's questions and concerns and those of the family. Its listed components are:
- communication with patients, families and health professionals
- listening skills
- compassion, sensitivity and respect for patients, families and colleagues
- sensitivity to diversity
- ethics and professionalism
The question the ABPMR says it answers: can you give appropriate explanations and respond ethically and sensitively to the patient and family, and communicate effectively and ethically with consultants, hospital staff and other interested parties?
Like every domain, it is scored independently. A weak Domain C does not drag down Domain E, and the reverse is also true.
Say the words, do not describe them
A common way to lose ground here is to narrate: "I would sit down, show empathy, and explain the prognosis." If the examiner sets up a role, speak in role. Use the words you would actually say, at the pace you would say them. Examiners take notes as you speak, so the ABPMR's advice to speak precisely and at a moderate pace matters even more here.
If you are not sure whether the examiner wants you to speak in role, it is fine to ask: "Would you like me to speak to her directly?"
A simple structure
For almost any Domain E prompt:
- Acknowledge. Name the feeling or the concern you just heard.
- Ask. Find out what they already know or what worries them most.
- Inform. Give honest information in plain language, in small pieces.
- Respond to emotion again. Pause. Let silence happen.
- Plan. What happens next, and what you will do together.
When a family member is hoping for full recovery
Prompt: The daughter of a 74-year-old woman with a large left middle cerebral artery stroke says, "The nurse said Mom might not go home. She's a fighter. She's going to walk out of here, right?"
"I can hear how much you love your mom, and she's lucky to have you fighting for her. Can I ask what you've noticed in therapy this week? ... You're right that she's working hard. I want to be honest with you about where things are, because you'll need that to plan. Her stroke was large, and right now she needs a lot of help to stand and to communicate. Some recovery is common in the first months, and we'll push for as much as we can. But it's also possible she'll need more help at home than one person can give, or a period in a facility. I don't want to take away hope; I want us to plan for both. Could we meet with her therapists and social worker this week and talk through what each option would look like?"
Why it works: it validates without agreeing to something untrue, asks before telling, gives information in plain words, keeps hope and realism side by side, and ends with a concrete plan that involves the team (which also touches Domain D).
When a patient is distressed
Prompt: A 45-year-old man with a new transtibial amputation says, "What's the point? I can't work, I can't do anything. My kids shouldn't have to see me like this."
"That sounds really heavy. Thank you for telling me. It's common to feel this way after an amputation, and it matters that you said it out loud. Can I ask you something directly: are you having thoughts of hurting yourself or ending your life? ... I'd like to get you some extra support, someone you can talk to about this, alongside the rehab. And I want you to know that a lot of people with your level of amputation walk with a prosthesis and go back to work, sometimes in a different role. Let's talk about what your work involves and what your kids need from you, because those are things we can work toward."
Why it works: it acknowledges the emotion, asks directly about suicidal thoughts (which is appropriate and expected), arranges support, and offers realistic hope tied to his own goals. If he answered yes, safety would come first: stay with him, keep him safe, and get an urgent mental health evaluation.
When a patient refuses a recommendation
Prompt: A patient with diabetes and a new foot ulcer refuses to stop weight bearing: "I have to work. I'm not using a wheelchair."
"It sounds like work is really important to you, and I want to help you keep it. Can you tell me what your job involves? ... Here's my concern: if you keep walking on this ulcer, it's likely to get worse and could lead to an infection or losing part of your foot, which would keep you off work much longer. Are there options that would work for you, like a walking boot, or a few weeks of modified duties? I can write to your employer. It's your decision, and I'll keep working with you whatever you choose."
Why it works: it explores the reason, explains the risk in plain words, offers alternatives, respects autonomy, and keeps the relationship.
When a colleague or the team disagrees
Domain E includes communication with other professionals. If the prompt involves a disagreement with a therapist, a consultant or an insurer, keep it professional: state the patient's need, listen to the other person's constraint, and propose a shared next step. Do not criticize a colleague in front of the patient or family.
Common traps
- Medical jargon. "Your AIS grade" or "anoxic injury" mean nothing to most families. Translate.
- False reassurance. "She'll be fine" is not honest if you do not know.
- Taking away all hope. Honest prognosis and hope can sit together.
- Lecturing. Long monologues leave no room for the family to speak. Short sentences, then pause.
- Forgetting the plan. End with what happens next.
How to practise
The ABPMR recommends practising cases through all five domains with a mentor or study partner. For Domain E specifically, have your partner play the family member and react to what you say, rather than reading a script. Record it and listen for jargon and length. If you do not have a partner, see practising Part II without a partner, and work through Domain E in the spinal cord injury sample vignette.
Frequently asked questions
- What is Domain E on the ABPMR Part II exam?
- Interpersonal and Communication Skills: communication with patients, families and professionals, listening, compassion and respect, sensitivity to diversity, and ethics and professionalism. It is scored independently of the other domains.
- Should I speak in role during Domain E?
- If the examiner sets up a conversation with the patient or family, speak directly in role using the words you would actually use. If unsure, ask the examiner whether they want you to speak to the person directly.
Sources
Facts in this guide were checked against these pages in October 2026. Board policies change; the board's own site is the authority.
Related guides
Practise it out loud
Reading answers is not the same as saying them under a clock. PMR Boards runs a voice examiner that asks the follow-up questions, holds you to time, and gives you a record of every run to review.